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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 4  |  Page : 795-797
Renal transplantation in obese patients


1 Gaziosmanpasa Hospital, Istanbul, Turkey
2 Göztepe Medical Park Hospital, Istanbul, Turkey

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Date of Web Publication24-Jun-2013
 

How to cite this article:
Gurkan A, Kacar S, Varilsuha C, Turunc V, Dheir H, Sahin S, Gurkan A, Kacar S, Varilsuha C, Turunc V, Dheir H, Sahin S. Renal transplantation in obese patients. Saudi J Kidney Dis Transpl 2013;24:795-7

How to cite this URL:
Gurkan A, Kacar S, Varilsuha C, Turunc V, Dheir H, Sahin S, Gurkan A, Kacar S, Varilsuha C, Turunc V, Dheir H, Sahin S. Renal transplantation in obese patients. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Oct 20];24:795-7. Available from: http://www.sjkdt.org/text.asp?2013/24/4/795/113893
To the Editor,

Performing surgical procedures in obese patients is more difficult, takes longer time and is subject to a higher rate of complications. [1],[2],[3],[4],[5] Analysis of over 50,000 renal transplant recipients in the United States Renal Data System (USRDS) demonstrated adverse graft survival among underweight and obese recipients, which were independent of the usual factors predictive of graft outcome. [6] Therefore, nephrologists are usually concerned about the outcome of transplantation in obese patients. In spite of this, the number of renal transplantations performed in obese recipients has increased by 116% between 1987 and 2001. [4],[5]

Obesity is a major health problem in Turkey as well, even among the dialysis population. [7],[8] Therefore, we conducted this retrospective study in 160 patients above the age of 18 years who underwent live donor renal transplantation between January 2008 and August 2009 to compare the outcomes and complication rates in the patients with body mass index (BMI) below 25 kg/m 2 (Group 1, n = 130) and above 30 kg/m 2 (Group 2, n = 30). All the patients received triple immunosuppression therapy including steroid, mycophenolate and calcineurin inhibitors, and were followed-up for at least one year. These two groups were compared in terms of post-operative surgical complications, post-operative hospitalization days, patient and graft survival rates and serum creatinine level at the end of the first year. The Mann-Whitney U test was used for unequal variances, chi-square test for categorical variances and Kaplan-Meier and log-rank tests for survival analysis using the SPSS 11.0 program.

The gender, age ranges of the patients and etiology of the renal failure are shown in [Table 1]. The average age of the patients in Group 1 was 35.5 ± 11.25 years (min 18 years to max 63 years) and in the obese group was 48.87 ± 10.01 years (min 27 years and max 63 years) (P <0.001). But, the average age of the donors were similar in the non-obese (47.28 ± 12.51) and obese groups (50.77 ± 14.1) (P = 0.406). human leucocyte antigen (HLA) mismatches between recipients and donors were found to be 3.47 ± 1.47 in the non-obese and 3.93 ± 1.31 in the obese groups (P = 0.076).
Table 1: Epidemiology of the patients.

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The average serum creatinine values at the end of the first year were 1.37 ± 1.14 and 1.44 ± 0.89 mg/dL in Group 1 and Group 2, respectively (P = 0.969). Also, the glomerular filtration rates at the end of the first year in Group 1 (70.3 ± 21.97 mL/min) and Group 2 (69.77 ± 20.43 mL/min) were similar (P = 0.980). The average hospitalization days after transplantation were statistically different in Group 1 (8.56 ± 7.11 days) and in Group 2 (13.8 ± 11.83 days) (P = 0.001).

In Group 1, seven (5%) patients had complications such as BK nephropathy (n = 2), arterial stricture (n = 1), surgical site infection (n = 1), strangulated hernia (n = 1) and urinary complications (n = 2). Two (1.5%) patients returned to dialysis due to BK nephropathy and two (1.5%) patients died due to sepsis and pulmonary emboli. The 1-year graft and patient survival were found to be 98.6% and 97.1%, respectively, in this group.

In Group 2, six (20%) patients had post-operative complications such as surgical site infection (n = 3), delayed graft function (DGF) (n = 2) and wound dehiscence (n = 1). One (3.3%) patient returned to dialysis and two (6.6%) patients died due to pulmonary fibrosis and myocardial infarction. The 1-year graft and patient survival were found to be 96.7 and 93.3%, respectively, in this group.

Although the complication rates were statistically significant between the two groups (P = 0.013), the mortality rate (P = 0.286), 1-year graft (P = 0.472) and 1-year patient (P = 0.299) survival rates were found to be statistically similar. In multivariate analysis, only recipients' age (P = 0.028) was found to be related with mortality. No relation was seen with BMI (P = 0.076), rate of return to dialysis (P = 0.121), acute rejection (P = 0.680), complication rate (P = 0.575), donors' age (P = 0.068) and number of HLA mismatch (P = 0.284) [Table 2].
Table 2: Multivariate regression analysis (dependent factor was death CI: 95%).

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The number of obese persons is increasing in many countries, including Turkey. [7],[9] Complications and outcomes of renal transplantation are considered to be worse among obese patients compared with their non-obese counterparts. [5],[10] But, it has been reported that patients who are even morbidly obese benefit from renal transplantation when compared with dialysis treatments. [11],[12] In our study, although the complication rate was found to be higher in the obese group, the patient and graft survival rates were similar. In addition, the annual mortality rate of our obese transplant patients was lower than the annual mortality rate of average dialysis patients reported by the Turkish Society of Nephrology. [13]

Obesity was found to increase the risk of DGF. [5] In this study also, obese patients encountered more DGF than their counterparts. Although DGF may not affect graft survival, it is associated with increased radio-diagnostic and pathological investigations, which prolong hospitalization, increase medical costs and risk for complications. [14] Obese patients in this series were discharged later (13.8 vs. 8.56 days) than the non-obese patients.

Because of the high complication rates and high hospital expenses, many centers are reluctant to perform kidney transplantation for obese patients. [4] However, our findings suggest that carefully evaluated recipients with elevated BMI do not experience worse outcome compared with non-obese patients. Obese recipients have an increased risk of complications and DGF, but have excellent 1-year allograft survival rates.

 
   References Top

1.Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL. The risks of surgery in obese patients. Ann Intern Med 1986;104:540-6.  Back to cited text no. 1
    
2.Cantürk Z, Cantürk NZ, Cetinarslan B, Utkan NZ, Tarkun I. Nosocomial infections and obesity in surgical patients. Obes Res 2003;11: 769-75.  Back to cited text no. 2
    
3.Romero-Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies. Lancet 2006;368:666-78.  Back to cited text no. 3
    
4.Segev DL, Simpkins CE, Thompson RE, Locke JE, Warren DS, Montgomery RA. Obesity impacts access to kidney transplantation. J Am Soc Nephrol 2008;19:349-55.  Back to cited text no. 4
    
5.Gore JL, Pham PT, Danovitch GM, et al. Obesity Obesity and outcome following renal transplantation. Am J Transplant 2006;6:357-63.  Back to cited text no. 5
    
6.Meier-Kriesche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: A significant independent risk factor for graft failure and patient death. Transplantation 2002;73:70-4.  Back to cited text no. 6
    
7.Satman I, Yilmaz T, Sengül A, et al. Population-based study of diabetes and risk characteristics in Turkey: Results of the turkish diabetes epidemiology study (TURDEP). Diab Care 2002; 25:1551-6.  Back to cited text no. 7
    
8.Süleymanlar G, Uta? C, Arinsoy T, et al. A population-based survey of Chronic Renal Disease In Turkey-the CREDIT study. Nephrol Dial Transplant 2011 ;26:1862-71.  Back to cited text no. 8
    
9.CDC.www.cdc.gov/chronicdisease/resources/p ublications/aag/pdf/2010/AAG_Obesity_2010.  Back to cited text no. 9
    
10.Cheung CY, Chan YH, Chan HW, Chau KF, Li CS. Optimal body mass index that can predict long-term graft outcome in Asian renal transplant recipients. Nephrology (Carlton) 2010;15:259-65.  Back to cited text no. 10
    
11.Glanton CW, Kao TC, Cruess D, Agodoa LY, Abbott KC. Impact of renal transplantation on survival in end-stage renal disease patients with elevated body mass index. Kidney Int 2003;63:647-53.  Back to cited text no. 11
    
12.Marks WH, Florence LS, Chapman PH, Precht AF, Perkinson DT. Morbid obesity is not a contraindication to kidney transplantation. Am J Surg 2004;187:635-8.  Back to cited text no. 12
    
13.Registry of the nephrology, dialysis and transplantation in Turkey 2008. Available from: http://www.tsn.org.tr/folders/file/registry (Last accessed on October 2011).  Back to cited text no. 13
    
14.Jindal RM, Zawada ET, Jr. Obesity and kidney transplantation. Am J Kidney Dis 2004;43: 943-52.  Back to cited text no. 14
    

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Correspondence Address:
Alp Gurkan
Gaziosmanpasa Hospital, Istanbul
Turkey
Alp Gurkan
Gaziosmanpasa Hospital, Istanbul
Turkey
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DOI: 10.4103/1319-2442.113893

PMID: 23816734

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[Pubmed] | [DOI]



 

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